SECTION TWO
STANDARD
INFECTION CONTROL
PROCEDURES
2.
STANDARD INFECTION CONTROL PROCEDURES
2.0
INTRODUCTION
Many communicable illnesses have the capacity to spread within any
communal
environment
where
there
is
shared
eating
and
living
accommodation, such as an elderly persons home.
Although this is possible, it is largely an avoidable complication if simple
Infection Control practices are adopted to minimise the spread of infection
from one person to another.
Standard Infection Control precautions are ways that employees can prevent
the transmission of infection from one person to another. They are practices
which should be routinely adopted with every individual regardless of whether
or not that person is known to have an infection.
2.1
STANDARD PRECAUTIONS TO PREVENT CROSS INFECTION

Effective hand washing by staff and service users is the single most
important Infection Control measure and should be carried out after
every contact. (See Section 2.3)

Disposable gloves and plastic aprons should be worn for all personal
care tasks and when in contact with blood or body fluids. (See Section
2.2)

Cuts and abrasions or skin lesions (broken skin, eczema and psoriasis)
should be covered by a waterproof dressing.

Blood and body fluids spillages should be dealt with immediately, as
detailed in Section 2.6

Sharps should be disposed of into an appropriate container (See
Section 2.7)

Clothing and bedding should be handled and machine washed, as
detailed in Section 2.5

Contaminated waste should be dealt with, as detailed in Section 2.4

Protect eyes, mouth and nose from blood splashes.
2.1.1
TRAINING
Training is of vital importance for staff, if they are to undertake their work
safely.
Under the requirements of the National Minimum Care Standards, workers in
the care sector are required to be suitably trained in Infection Control. This
publication forms an essential part of Leicestershire County Council’s Adult
Social Care Service, Infection Control training programme.
The Care Home Regulations 2001 section 19 (5) (b) require that care workers
have … "qualifications suitable for work that he is to perform and the skills
necessary for that work”.
2.2
PERSONAL PROTECTIVE EQUIPMENT
What protective equipment should be available?

Disposable gloves

Disposable plastic aprons

Protective eye goggles / visors

Masks (there may be rare occasions when this is required)
Why should protective equipment be used?

The hands and clothing of staff can become contaminated with germs
and potentially spread infection.

If used correctly, protective equipment can prevent the spread of
infection and also protect the wearer from cross infection.
When should protective equipment be used?

Disposable plastic aprons and gloves should be worn when there is a
potential or actual risk of coming into contact with blood or body fluids.

Protective eye wear should be worn when carrying out procedures
involving a risk of blood or body fluid splashes to the eyes or mucous
membranes e.g. mouth
2.3
HAND WASHING AND HAND HYGIENE
Why should hands be washed?
Hand washing is the single most important measure in reducing cross
infection. Effective “hand hygiene” will reduce the risk of staff contaminating
themselves with germs from the environment and from transmitting the same
germs to service users and other staff.
Hand Hygiene
“Hand Hygiene” is the term we now use for the process of hand washing.
Hand hygiene relates not just to hand washing but all the processes involved,
e.g. rinsing, drying and care of skin afterwards.
It is important that nails are kept short and clean. Nail polish, false nails and
infills can be a possible source of cross infection and injury. Kitchen staff
specifically, are prohibited from wearing jewellery and nail polish, false nails
and infills. Each unit may need to undertake a risk assessment to decide on
the appropriateness of such issues (see Appendix).
Occupational Dermatitis is caused by the skin coming into contact with certain
substances at work; it affects all industry and business sectors. It is not
infectious but hands that are constantly being washed need to be cared for.
Use a moisturising cream before and after work to prevent water loss from the
outer layer of your skin by covering it with a protective film. This keeps the
water in the skin and helps keep infections and other harsh substances out
(see Appendix 6.8, Preventing Occupational Dermatitis).
HAND WASHING AND HAND HYGIENE – cont.
2.3
When should hands be washed?

Before and after each work shift or work break

After handling potentially contaminated items such as waste, used
linen, soiled wound dressings or medical equipment

Before and after any clinical procedure e.g. when emptying / changing
a catheter bag or when undertaking wound care

Before putting on and after removing protective clothing

After using the toilet

Whenever hands become visibly soiled

Before eating, drinking or handling food

After removal of gloves
NB – Staff in residential units should not use residents’ bar soap or hand
towels
HAND WASHING AND HAND HYGIENE – cont.
2.3
How should hands be washed?

Wet hands up to wrists under running water

Apply a liquid soap

Using the 6 steps technique rub soap evenly over all areas of hands
including front, back, in between fingers, thumbs and the tips of the
fingers of both hands

Rinse off every trace of lather with running water

Dry hands thoroughly, preferably with disposable paper towels or hot
air dryer

All staff should ensure that wounds, cuts and abrasions to hands are
covered with a waterproof dressing while at work

Experiments have shown that the tips of thumbs and fingers are often
missed when washing hands, the pictures overleaf show how to wash
hands effectively and efficiently

Where hand washing is not possible and hands are not visibly soiled,
alcohol hand rubs may be useful
Good Hand Washing Guide
Good Hand Washing Guide – Let’s all do the 6 steps poster
2.3.1
JEWELLERY AT WORK GUIDANCE NOTES
Several incidents have arisen nationally that highlight the need for advice on
the wearing of jewellery in the workplace, particularly in social care work. It is
acknowledged that some types of jewellery are worn specifically as an
indicator of a religious belief or practice, and therefore the wearing of jewellery
can become a delicate issue. However, these guidance notes seek only to
address speculation on best practice from an Infection Control and Food,
Health & Safety perspective.
When social care staff, particularly those who carry out personal care duties,
wear jewellery there is a potential for harm both to the service user and the
wearer. Jewellery can potentially be snatched or grabbed, or become
entangled in equipment. Watches, rings, bracelets, brooches etc with stones
or engravings have the potential to cut or scratch a service user. Ornate
jewellery, apart from harbouring dirt and bacteria, may also easily tear
disposable gloves, which are necessary for the prevention of infection. In
addition all jewellery has the potential to harbour dirt and bacteria, leading to
cross contamination and infection. It is recognised that there are certain
aspects of care work where it is acceptable to wear fob watches, e.g. nursing.
In situations such as this the latter must be positioned where they can cause
no harm to anyone and not be easily grabbed.
2.3.1 JEWELLERY AT WORK GUIDANCE NOTES– cont.
Managers may choose to carry out their own risk assessments on the wearing
of jewellery. However, the consensus view amongst local authorities
nationwide is as follows: –

No jewellery with the potential to cause harm to service users and/or
that can be grabbed or snatched, i.e. necklaces, earrings, bracelets,
brooches, watches (wrist or fob) or other facial jewellery should be
worn at work. The possible exceptions to the above are stud-type
earrings or other stud-type facial piercing. However, if these are still
considered to be a potential problem they can be covered with
waterproof plasters.

Where practicable any jewellery being worn by persons delivering care
should be either removed or covered using a waterproof plaster.

Body piercings should remain covered by clothing or where this is not
possible, removed before commencing duty.

Rings with stones which may cut or scratch, particularly whilst carrying
out personal needs duties, should not be worn. The only exception to
this is a plain, band-type ring, i.e. wedding ring and, if deemed
necessary, this can be taped over and covered in a waterproof plaster.

In a kitchen or food preparation setting Food Safety Legislation and
departmental policy, detailed in the departmental the good food guide
prohibits the wearing of jewellery other than sleepers and plain band
(wedding) rings.
2.3.2
Jewellery at Work Poster
Uniforms and Dress Guidance
For Kitchen Staff
The wearing of jewellery, namely wrist watches, fob
watches, earrings, rings, necklaces, bracelets,
bangles, anklets or brooches is forbidden, as they
harbour dirt and bacteria. The only exception to this
rule is sleepers in pierced ears and plain band
rings. The only facial jewellery permitted is a small
stud without stones. This must be safely secured to
avoid physical contamination which contravenes
food safety legislation.
Extract from the good food guide
Practice Guidance Page 17
Procedures Pages 16 and 17
2.4
SAFE MANAGEMENT OF CONTAMINATED WASTE
All waste must be segregated depending on its type (see the chart below).
Current guidelines from Leicestershire County Council Waste Management,
DEFRA, HSE and CQC all indicate that waste collected from local authority
establishments will continue to be classified as “domestic” and not “clinical” or
“hazardous” waste, as defined under the terms of the Hazardous Waste
(England and Wales) Regulations 2005.
How should waste be segregated?
Staff should be taught the correct segregation of waste, basic hygiene and
infection control including dealing with body fluids and incontinence
management. Care workers should be made aware of the particular system
used within their work setting, as procedures may vary depending upon
facilities and staffing levels.
What type of waste?
What should you do with it?
“Clinical waste” (as defined by the
above regulations) produced by
health
care
professional
visits
(doctor/nurse) e.g. waste soiled with
blood or body fluids
The health professional may deal with
this “clinical” waste themselves,
removing it typically in a yellow bag
marked for INCINERATION ONLY.
Alternatively some establishments
may make arrangements locally or
double bag. A flush toilet is ideal for
disposing of faeces and urine and
should be used whenever possible.
Normal household waste, general Black or clear bags
commercial waste
Waste handled by care staff e.g. Use system such as “twist and seal”
sanitary towels, nappies, incontinence or double bag and seal securely. Can
pads and dressings used in routine be placed in household waste in
care activities
normal black sacks – unless a risk
assessment highlights the need for
more stringent precautions.
Pharmaceutical waste (such as Return to chemist for disposal in
tablets, ointments, creams etc)
SPECIAL WASTE bin or other action
indicated
by
the
department’s
Medication Policy
2.4
SAFE MANAGEMENT OF CONTAMINATED WASTE – cont.
What type of waste?
Needles and other
sharps
What should you do with it?
contaminated Store in an appropriately sized
dedicated sharps box which complies
with BS7320 and UN3291. Should be
disposed of appropriately when the
line is reached.
In an emergency use a solid
container (e.g. sealed glass jar).
Waste bags should be securely fastened and ALWAYS deposited in
appropriate bins, which are inaccessible to the general public, animals and
vermin. All bins should be of British Standard, to ensure they are strong
enough to withstand frequent use.
2.5
SAFE MANAGEMENT OF LAUNDRY
The provision of clean linen is a fundamental requirement of care. Incorrect
handling, laundering and storage can pose an infection hazard.
Infection can be transferred between contaminated and non contaminated
items of clothing, laundry and the environment it is stored in. Even during a
normal washing cycle a number of micro-organisms can be passed between
clothing and linen and will only be partially removed during the rinse cycles.
Thorough drying of the laundry, however, does reduce the levels of
contamination to an amount that no longer poses a risk.
Although staff may not regularly handle soiled laundry, they should be taught
how to handle it safely. It is important to remember that it is not always
possible to know if linen is infected or contaminated with an infectious disease
and therefore it is vital that all used laundry is treated with care and Standard
Precautions (including wearing personal protection equipment) are adopted at
all times.
SAFE MANAGEMENT OF LAUNDRY – cont.
2.5
Requirements for Laundry

A designated laundry area. Ideally, this area should have separate
ventilation and a dirty to clean through system so that dirty laundry can
arrive through one door and be quickly washed before drying and
removal through a separate exit to a clean storage area. Where this is
not possible arrangements must be made to ensure a dirty to clean
workflow, so that clean and dirty laundry is kept separate.

Washing machines in residential care homes should have “specified
programme ability” to meet disinfection standards*. Ideally this will
include a pre-wash service cycle.

In care home settings an industrial dryer that is regularly
maintained should be used to dry all clothing and linen.

In care homes, a regular service and maintenance inspection
schedule should be available for examination by CQC inspectors.*

A wash hand basin preferably with lever taps, liquid soap and
disposable towels
* Reference – Department of Health, Infection Control Guidance for Care
Homes (June 2006).
2.5
SAFE MANAGEMENT OF LAUNDRY – cont.
Training for Laundry Staff
Legislation requires laundry staff to have training in the following areas:-

Infection Control

Manual Handling (inanimate objects)

COSHH
In addition laundry staff should receive instruction concerning:-

Cleaning Schedules

Standard Infection Control Procedures

Hand Hygiene

Sluicing

Colour coding for laundry

Type and category of laundry
2.5
SAFE MANAGEMENT OF LAUNDRY – cont.
How should laundry be handled?
1. Laundry must be handled, transported and processed in such a
manner that prevents skin and mucous membrane exposure to staff,
contamination of their clothing and the environment and the infection of
service users.**
2. Before handling dirty laundry, staff should wear protective clothing
(gloves and apron).
3. Linen should be removed from residents’ beds with care, avoiding
creating dust and put in the appropriate bag outside the room.
4. Personal clothing should also be removed with care and placed in the
appropriate linen bag and not on the floor.
5. Linen should be separated into the correct containers, handled as little
as possible and bagged at the point of use.
6. Linen bags containing infected laundry should be sealed and tied
before removal from the care area.**
7. Staff should never empty bags of linen onto the floor to sort it into
categories as this presents an unnecessary risk of infection.
8. Linen should be segregated into 3 categories (see segregation). Many
care homes use water-soluble / alginate bag liners within cotton sacks
in a washable, plastic, wheeled trolley to aide this separation: keeping
linen off the floor before taking the bags to the laundry.
9. All soiled laundry should be placed directly into the washing machine. If
this is not possible then soiled laundry should be placed into a plastic
bag until it can be put into the washing machine.
10. Hands must be washed after handling dirty laundry and following
removal of personal protective equipment.
11. Each establishment / service should carry out their own risk
assessment if in doubt as to how laundry should be handled, ensuring
that dirty and clean linen are stored separately.
12. Where water-soluble bags are used these should never be opened
once sealed, prior to transfer into the washing machine.
2.5
SAFE MANAGEMENT OF LAUNDRY – cont.
How should linen be segregated?
1. Laundry facilities should be sited so that used / soiled items and
infected linen are not carried through areas where food is stored,
prepared, cooked or eaten and not intrude on service users.**
2. Ensure that dirty and clean linens are stored separately.**
3. Residential care homes are required to have sluicing facilities.
However, avoid manual sluicing where practicable.
4. Soiled communal laundry e.g. pillowcases, sheets, towels should be
washed at a temperature of 65°C or above.
5. Soiled communal laundry e.g. pillowcases, sheets, towels should be
washed separately from other clothing on the hottest temperature the
clothing will allow (65˚C or above).
6. Foul / soiled or infected laundry to be washed at an appropriate
temperature (minimum of 65°C for not less than 10 minutes or 71°C for
at least 3 minutes).*
7. The most recent guidance on Infection Control ** advises that “laundry
can be safely washed in a domestic washing machine in water as hot
as the fabric will tolerate, washed separately from other linen, in a load
not more than half the machine capacity, in order to ensure adequate
rinsing and dilution; then tumble dried and ironed”.
References from:** The Department of Health Pandemic Influenza Guidance.
Issued in October 2005
* Care Homes for Older People National Minimum Standards
** Department of Health – Infection Control Guidance for Care Homes
June 2006
2.5
SAFE MANAGEMENT OF LAUNDRY – cont.
What type of laundry?
What type of linen bag?
Linen should be categorised as “Infected” or “Used / or “Soiled / Foul”
Normal “Used” linen
Standard linen bag, washable plastic
bucket, black plastic bags or similar
sealed container for collection by
laundry service or storage at
establishment prior to
washing/disinfecting on site.
“Soiled / Foul” linen soiled with blood, At premises with laundry facilities,
faeces or urine
sluice immediately (using the prewash facility on the washing machine,
if available) and machine
wash/disinfect. Some non-residential
establishments may decide to sluice
soiled items only and return item in
sealed plastic container to service
user. Minimise handling where
practicable.
“Infected” linen that has been in Wear disposable apron and gloves,
contact with a client with a known then bag and wash/disinfect
infection
separately. Minimise handling where
practicable. N.B. - Soluble alginate
bags which dissolve in the wash can
be purchased to avoid repeated
handling of the contents.
2.6
SAFE MANAGEMENT OF BODY FLUID SPILLAGES
Urine
Urine is sterile unless infected; therefore cleaning with general-purpose
detergent is adequate.

Wear disposable gloves and aprons

Wipe up spillage with paper towels

Clean with general-purpose detergent and hot water

Rinse and dry

Dispose of PPE and wash hands
Faeces, vomit or pus

Wear disposable gloves and apron

Wear protective eye goggles if there is a risk of splashes to the eyes

Wipe up spillages with disposable paper towels

Disinfect area with bleach (chlorine based solution i.e. Milton or 1%
sodium hypochlorite solution left for 2 minutes) rinse and dry

Place used paper towels, gloves and apron in yellow plastic bag or
double bag and dispose of as contaminated waste
NB
Bleach must not be mixed with urine as it gives off a toxic gas. It can
also cause discoloration of wood, and pitting of metals.
SAFE MANAGEMENT OF BODY FLUID SPILLAGES – cont.
2.6
Minor Blood Spillages

Wear disposable gloves and apron

Wear protective eye goggles if there is a risk of splashes to the eyes

Ensure adequate ventilation

Place paper towels over the spillage. Gently pour a 1 in 10 dilution of
household bleach or undiluted Milton onto a paper towel and wipe up
spillage. Clean area with bleach and leave for 2 minutes minimum.

Or use chlorine granules (Haz Tab) to soak up the blood. Alternatively
a proprietary brand of cat litter can be used to mop up spillages. It is
relatively cheap and light to store and use. It does not have
guaranteed disinfection qualities however, so cleaned surfaces will
also need to be disinfected (and dried) as described above.
A single use spill kit is available for passenger transport which
provides sufficient PPE and chemicals for one incident. Contact your
Line Manager for details of how to obtain a spill kit.

The treated surface and/or equipment should be rinsed with clean
water and dried, as bleach solutions can be corrosive. No other
precautions are necessary

If blood has been spilt on absorbent surfaces (carpets/soft furnishings)
follow the same procedure as above and clean with hot water and
detergent

Discard paper towels, gloves and aprons in an appropriate waste bag

If soft furnishings cannot be cleaned with bleach then they may need
to be destroyed
2.7
SAFE USE AND DISPOSAL OF NEEDLES AND SHARP
INSTRUMENTS
Sharp instruments may cause injury to service users and staff. If
contaminated with infected blood such injuries can cause the transmission
of blood-borne viruses such as Hepatitis B, Hepatitis C and HIV. (Section
4.1)
What are sharps?

Needles

Scalpels

Broken glass

Razor blades

Any other item which may cause laceration or skin puncture and which
may have been contaminated with blood from another individual.
2.7
SAFE USE AND DISPOSAL OF NEEDLES AND SHARP
INSTRUMENTS – cont.
How can the risk of injury be reduced?
To reduce the risk of sharps injury, the safe handling and disposal of sharps is
very important. The following advice needs to be followed when dealing with a
sharp instrument.

Never re-sheath needles

Dispose of syringe and needle, as one unit, into a specific container

Sharp instruments, once used or when found, need to be placed into a
designated sharps box which must comply with European and British
standards

Sharps containers must be securely assembled prior to use

Sharps must not be carried around. Take the sharps box to where
the sharp is going to be used or to where a possibly infected sharp has
been found. It can then be disposed of immediately

Sharps boxes must be closed and sealed when they have reached the
full line

Sharps boxes should be labelled with the name of the establishment
prior to disposal

Sharps boxes must be stored in a safe place away from unauthorised
people and children

Consider the possibility of hidden sharps such as needles and razors
when carrying out your work. Wear protective equipment and look
before touching
2.8
SAFE MANAGEMENT OF SHARPS INJURIES, BITES, SCRATCHES
& BLOOD OR BODY FLUID SPLASHES TO EYES OR MOUTH &
BLOOD SPILLAGES
What should you do immediately following a sharps injury (including
bites or scratches that draw blood?

Make the wound bleed freely (do not suck the injury)

Wash injury under warm running water while continuing to encourage
bleeding

Dry and cover injury with a waterproof dressing

Safely retain the sharp object for testing in a plastic bag inside a sealed
container

Report immediately to a First Aider, and/or your line manager. The
Community Infection Control Nurse or your GP can provide further
advice and management

LCC staff should fill out an accident form and forward a copy as per
departmental instructions to the Departmental Senior Health, Safety &
Wellbeing Advisor or send an electronic copy by following the
instructions on the departmental intranet site
WASH IT – BLEED IT – COVER IT – REPORT IT
2.8
SAFE MANAGEMENT OF SHARPS INJURIES, BITES,
SCRATCHES & BLOOD OR BODY FLUID SPLASHES TO
EYES OR MOUTH & BLOOD SPILLAGES – cont.
What should you do following splashes of blood to the eyes or mouth?

Splashes of blood or body fluids entering the eye should be removed
immediately by irrigation. Ideally sterile, saline or eye wash packs
should be used if available. If not running mains water can be used
instead. Irrigation should be continued until all traces of the
contaminated material have been removed

Report immediately to a First Aider, and/or your line manager. The
Community Infection Control Nurse or your GP can provide further
advice and management

LCC staff should fill out an accident form and forward a copy as per
departmental instructions to the Departmental Senior Health, Safety &
Wellbeing Advisor or send an electronic copy by following the
instructions on the departmental intranet site
Following these simple First Aid measures the risk of transmitting infection will
be reduced and managed. In practice staff and service users will usually be
referred to their General Practitioner or Hospital Accident and Emergency
Department.
2.8
SAFE MANAGEMENT OF SHARPS INJURIES, BITS, SCRATCHES &
BLOOD OR BODY FLUID SPLASHES TO EYES OR MOUTH &
BLOOD SPILLAGES
What should you do following spillage of blood onto skin?

ON UNBROKEN SKIN – wash off with copious warm water and soap,
paying particular attention to fingernails. No further action necessary.

ON BROKEN SKIN – wash off with copious warm water and soap. The
incident must be reported to your line manager and The Community
Infection Control Nurse with the accident reporting procedure followed
as normal.

Significant blood spillages must be reported to your line manager and
the cleaning of such spillage should be discussed. Departmental Senior
Health, Safety & Wellbeing Advisors or The Food & Nutrition Manager
are available for further advice.
2.8.1
SHARPS INJURY FLOWCHART
Occupational exposure to blood or body fluids
Needle stick injuries, cuts, bites, splashes into eyes,
nose and mouth or other cuts/abrasions on skin
FIRST AID
Encourage wound to bleed. Wash contaminated area with copious amounts of water
DO NOT SUCK THE WOUND,
DO NOT SCRUB THE AREA
OR USE A NAIL BRUSH
Cover wound with an appropriate dressing
Report the accident to the person in charge as soon as possible
Complete an Incident / Accident form and send to the Departmental Senior Health, Safety &
Wellbeing Advisor
Splash to broken skin/eyes
with blood or with other
blood-stained body fluids
e.g. urine
Medium/high risk
Monday to Friday
Telephone your GP and ask to be seen as soon as
possible*
At all other times
Telephone your local A&E Department and ask to be
seen*
*Take a written account of the incident, agreed and
signed by the person in charge, and information on the
patient/resident/staff with whose blood/body fluids you
have been accidentally contaminated
Your GP or A&E staff will assess the risk Blood samples
may be taken
Appropriate prophylaxis for Hepatitis B/immunoglobulin will
be offered if indicated by risk
Splash to intact skin with
blood or with other low risk
body fluids e.g. urine, NOT
visibly blood-stained
Low risk
If injured member of staff
agrees that exposure is
low risk – no further
action need be taken
2.9
ENVIRONMENTAL CLEANING
Effective cleaning is not only an essential Standard Infection Control
Procedure, but is also an outward and visible sign of the overall quality of care
provided.
As a general principal the overall appearance of care settings should be tidy,
ordered and uncluttered with only appropriate cleanable, well maintained
furniture used. Any presence of blood or body fluids is unacceptable. In
general all surfaces should be free from dust, dirt, debris, stains and spillages.
The fabric of the environment and equipment should smell fresh and pleasant.
Any deodorisers should be clean and functional.
A key component of providing consistent high quality cleaning is the presence
of a clear cleaning schedule which sets out all aspects of the cleaning service
and its frequency. It should also clearly define the roles and responsibilities of
all those involved, from managers through to care, domestic and
housekeeping staff.
Departmental publications The Kitchen Log Book and the good food guide
contain examples of cleaning schedules. Cleaning schedules can also be
obtained from Johnson Diversey. Where cleaning services are contracted
managers will need to ensure that an appropriate cleaning schedule is
agreed. For both in house and contracted cleaning services, managers must
ensure that suitable arrangements are in place to monitor the standards of
cleaning and deal with any poor or unsatisfactory performance. For LCC staff
Property Services and The Food & Nutrition Manager play a role in this
monitoring when they undertake audits.
ENVIRONMENTAL CLEANING – cont.
2.9
Decontamination
Within care settings, decontamination of equipment, medical devices and the
environment should be a frequent occurrence. However, it is extremely
unlikely that the sterilisation of medical devices will be required. Indeed, if this
level of decontamination is needed it should be sought from an accredited
Sterile Services Department, or single use disposable instruments should be
used.
Decontamination processes
Decontamination can be achieved by a number of methods, which fall into the
following 3 categories:

Cleaning physically removes contamination but does not necessarily
destroy micro-organisms. It removes micro-organisms and the organic
matter on which they thrive. Cleaning is a necessary prerequisite to
effective disinfection or sterilisation. This will be the most common
choice of decontamination method within a care setting.

Disinfection reduces the number of viable micro-organisms but may
not necessarily inactivate some microbial agents, such as certain
viruses and bacterial spores.

Sterilisation renders an object free from viable micro-organisms
including viruses and bacterial spores.
The choice of decontamination methods depends upon the risk of infection to
the service user coming into contact with equipment or medical devices. Such
items can be categorised into 3 risk groups:

High risk items are those used to penetrate skin or mucous
membrane: or enter the vascular system or sterile spaces, for example
needles and catheters. They need to be sterilised if reusable, but single
use items are preferred.
ENVIRONMENTAL CLEANING – cont.
2.9
Decontamination – cont.

Intermediate risk items are those which come into contact with intact
mucous membranes or may be contaminated with particularly virulent
or readily transmittable organisms, for example commodes used by a
service user with a known infection. Such items require cleaning
followed by disinfection or sterilisation.

Low risk items are those which come into contact with intact skin or do
not contact the service user e.g. floors, walls. They require cleaning.
See Table 2.9.1 for Suggested Decontamination Methods for Commonly Used
Equipment.
ENVIRONMENTAL CLEANING – cont.
2.9
Single use instruments
As an alternative to sterilising reusable medical instruments, the use of single
use disposable equipment is becoming increasingly popular. Although many
items, such as syringes and needles, have been available for many years, the
cost, quality and availability of other equipment and instruments have resulted
in a significant increase in single use devices. Any device designated as
single use must never (under any circumstances) be reused.
Manufacturers’ Responsibilities
Manufacturers of reusable medical devices are required by the Medical
Devices Directive (93/42/EEC) to supply clear written decontamination
instructions, which should include appropriate cleaning, disinfection or
sterilisation methods.
Certain fabrics or materials can be difficult to decontaminate. It is therefore
advisable, prior to purchasing equipment, for example hoists and slings to
assess carefully that the recommended decontamination methods are
practical, safe and reliable.
General principles for chemical disinfection

Chemical agents should only be used where:




Sterilisation is not required
It is impossible to disinfect using heat
Cleaning alone is insufficient
Disinfectants should not be used routinely as cleaning agents or
deodorants

Disinfectants must not be used for the storage of equipment e.g.
mops
ENVIRONMENTAL CLEANING – cont.
2.9
Manufacturers’ Responsibilities – cont.

Organic debris (e.g. faeces, secretions) may inactivate some
disinfectants. Items should be cleaned prior to chemical disinfection.

Disinfectants must be used at the recommended dilution.

Disinfectants must be stored and discarded in accordance with the
manufacturers’ instructions.

COSHH regulations must be adhered to.
2.9.1
SUGGESTED DECONTAMINATION METHODS FOR COMMONLY
USED EQUIPMENT
If items are contaminated with blood or other body fluids, clean them thoroughly to
remove physical soil and then wipe with a freshly prepared solution of chlorinereleasing agent with a concentration of 1000 p.p.m.
Bedding
See 2.5 – Safe Management of Laundry.
Heat disinfection: 65°C for 10 minutes or 71°C for 3
minutes.
For heat-sensitive fabrics use a low temperature at 40°C
and tumble dry
Bedpans and urinals
Dispose of single-use items. If reusable, heat disinfectant
in bedpan washer-disinfector (e.g. 80°C for 1 minute).
Store dry.
Combs
Each service user should have their own comb
Commodes
Wash with detergent, rinse and dry.
Curtains
Should be laundered at least six monthly intervals.
Drip stands
Clean after each use.
Flower vases
Change water regularly. Wash vase in hot water and
detergent after use and store dry
Hoist
Surface clean the hoist frame. Examine material and
clips for wear or damage before each use. Slings should
be laundered in the hottest wash cycle allowable and
ideally, not shared between service users.
Glucose-monitoring equipment
Clean after each use.
Mattresses and covers
Clean cover regularly as part of a routine and following
service users use. Rinse thoroughly and dry. Mattresses
should be enclosed in a waterproof cover and routinely
inspected for damage. Discard if fluids have penetrated
into the mattress fabric.
Nebulisers
Clean all parts thoroughly with detergent and hot water
between service users use. Ensure all parts are
thoroughly dried. Refill with sterile water only. Do not
share between service users.
Dispose of on service user’s discharge.
Scissors
Clean following each use.
Vaginal speculae
Dispose of single-use
Splints and walking frames
Wash and clean with detergent
Thermometers (electronic, oral
and rectal)
Use a single-use sleeve each time.
Trolley (dressing, medicine),
tables
Clean with detergent and hot water and dry.
Wheelchairs
Clean, rinse and dry.